Check a Box. Save a Life: How Student Leadership Is Shaking Up Health Care and Driving a Revolution in Patient Safety Daniel Henderson, BS,*Þ Andrew Carson-Stevens, BSc,þ Jordan Bohnen, AB,§ Lily Gutnik, BA,|| Shabnam Hafiz, MPH,¶ ** and Shannon Mills, MHSÞÞ Objectives: The objective was to engage health professions students as leaders in spreading the World Health Organization Surgical Check- list. The published impact of the checklist in reducing surgical compli- cations and deaths, combined with its ease of use, offers an ideal target for students to save lives and prevent suffering. As members of the BCheck a Box. Save a Life.[ campaign, students can speed the pace of patient safety improvement. Methods: The campaign was developed around an online Webcast event, designated its launch. Outreach was conducted mainly through social media, especially the popular networking Web site, Facebook. The Institute for Healthcare Improvement’s Open School for Health Professions and the American Medical Student Association provided a source of potential campaign members. Results: One hundred eighty-two registrants, representing 122 distinct hosting institutions, signed up for the launch event. Based on hosts’ pro- jected event sizes, assessed in a registration questionnaire, approximately 1400 students are believed to have participated in the event. After the launch, these students joined the campaign and were invited to carry out projects in their home institutions. Six weeks after the launch, the campaign reconvened at the Institute for Healthcare Improvement’s 21st Annual National Forum, and attendees presented case reports of 15 pro- jects they had undertaken since the launch. Conclusions: As an independent, self-organized, decentralized effort and an application of student social organizing to the cause of patient safety, BCheck a Box.[ is a landmark achievement. Leveraging social media and disrupting the traditional model of safety leadership, the campaign offers hope for the future of patient safety. Key Words: patient safety, medical student education, surgical safety, WHO Surgical Safety Checklist, social media, student organizing, health profession education (J Patient Saf 2010;6: 43Y47) L ast October, students around the globe decided to miss class. How did their deans respond to this truancy? With praise. BThis is a wonderful opportunity; how can I help?,[ asked the dean of a California medical school. BEnjoy the teach-in[ (oral communication, October 21, 2009). In 14 countries, nearly 1400 students in health profes- sions trainingVnursing, medicine, pharmacy, public health, and health administration programsVcame together for a virtual teach-in on patient safety. In doing so, they joined a movement that has surprised even the visionary Don Berwick in its spread. Their cause: safer surgery. Under the banner of BCheck a Box. Save a Life.[ A rallying around the World Health Organiza- tion (WHO) Surgical Safety Checklist, these students represent a previously untapped cohort of activists with the potential to drive reforms in patient safety. This article tells the story of how this new social movement took shape and forecasts its poten- tial to triumph over the famously resistant culture of medicine. Ten years after the Institute of Medicine released its land- mark report, To Err Is Human, improving health care has be- come a focus of providers, administrators, hospitals, and payer organizations. Despite these developments, health care has re- sponded slowly, if at all. The Agency for Healthcare Research and Quality’s most recent National Healthcare Quality Report actually shows a 1% decline in patient safety measures. 1 Against this gloomy picture, a new glimmer of optimism shines through, in the form of a grassroots student movement organizing for patient safety. Using the impact of the WHO Surgical Safety Checklist as their call to action, thousands of students from around the world are championing safety. 2,3 These future health professionals are self-organized, largely unfunded, and decentralized. Furthermore, they are leveraging social networks and new media in ways that are unprecedented in the field of health care improvement. Borrowing techniques from established social organizers such as Marshall Ganz and the 2008 Obama campaign, this new movement has the potential to save hundreds of thousands of lives and profoundly shake up the current model of health care leadership. Indeed, as the next generation of health care leaders, their energy foretells a revo- lution in the sluggish culture of medicine. SOWING THE SEEDS OF CHANGE: DON BERWICK’S CONVERSATION WITH THE FUTURE The movement was conceived in December of 2008, at the 20th Annual National Forum of the Institute for Healthcare Improvement (IHI). 4 There, IHI President and CEO Don Berwick and Atul Gawande presented new findings about a checklist to reduce surgical complications and deaths. The crowd was tanta- lized by the sneak preview of Gawande’s results, 1 month before his article in the New England Journal of Medicine would dem- onstrate the checklist’s potential to save lives, prevent suffering, and cut costs. 5 In his keynote address, Dr Berwick offered a chal- lenge to his audience: BLet’s put our network to work. I propose a sprint[ (oral communication, December 10, 2008). Berwick urged his audience of thousands to use the checklist in 1 operating room at their institutions within 90 days. Dr Gawande was excited about ORIGINAL ARTICLE J Patient Saf & Volume 6, Number 1, March 2010 www.journalpatientsafety.com 43 From the *University of Connecticut School of Medicine, Farmington, Connecticut; †American Medical Student Association, Reston, Virginia; ‡School of Medicine, Cardiff University, Wales, UK; §Harvard Medical School, Boston, Massachusetts; Harvard Business School, Boston, Massa- chusetts; ||Medical School for International Health, Ben Gurion University, Beer Sheva, Israel; ¶Harvard School of Public Health, Boston, Massachusetts; **University of California Davis School of Medicine, Sacramento, California; and ††Institute for Healthcare Improvement, Cambridge, Massachusetts. Correspondence: Daniel Henderson, BS, American Medical Student Association, 1902 Association Dr, Reston, VA 20191 (e-mail: daniel.henderson@gmail.com). Funding support for this article was provided by the American Medical Student Association. Copyright * 2010 by Lippincott Williams & Wilkins Copyright @ 20 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 10